Provider Demographics
NPI:1477336857
Name:COX, JODIE M
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:M
Last Name:COX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JODIE
Other - Middle Name:M
Other - Last Name:WILMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:114 NIGHTINGALE LN
Mailing Address - Street 2:
Mailing Address - City:NORTH TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24630-9594
Mailing Address - Country:US
Mailing Address - Phone:540-588-5384
Mailing Address - Fax:
Practice Address - Street 1:1908 GLENWOOD PARK RD
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24739-7969
Practice Address - Country:US
Practice Address - Phone:304-323-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001312185163WE0003X, 163WH0200X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WH0200XNursing Service ProvidersRegistered NurseHome Health